"Nothing for Us Without Us": Normalising patient and public involvement and engagement in national clinical audits and health system improvement.

BACKGROUND

Patient and Public Involvement and Engagement (PPIE) is increasingly recognised as essential to patient-centred care, transparency, and health system improvement. However, how PPIE is operationalised within national clinical audit systems remains poorly described.

OBJECTIVE

To examine how PPIE is embedded and operationalised across Ireland's National Office of Clinical Audit (NOCA) and to identify the organisational mechanisms that support sustained involvement.

METHODS

We conducted a documentary content analysis of 23 publicly available NOCA materials from 2012 to 2025, including governance documents, national audit reports, communication outputs, and patient story media. A targeted review of PPIE policy and guidance contextualised the findings.

RESULTS

Four themes characterised documented PPIE integration within NOCA: (i) governance integration, (ii) portfolio-level coordination, (iii) co-production of public-facing outputs, and (iv) institutional support mechanisms. Across multiple national audits, public documents described PPIE contributions to governance discussions, interpretation of findings, and communication outputs; the analysis did not assess the quality of participation or causal effects on clinical outcomes.

CONCLUSIONS

The NOCA case illustrates how PPIE can be incorporated within a national clinical audit infrastructure as a recurring governance and accountability function. It offers a pragmatic model that may be adaptable to other health systems, subject to local resources, representation and evaluation.